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Sleeping pills common


Medications That Can Help You Sleep

Written by WebMD Editorial Contributors

In some cases, doctors will prescribe drugs for the treatment of insomnia. All insomnia medications should be taken shortly before bed. Do not attempt to drive or perform other activities that require concentration after taking an insomnia drug because it will make you sleepy and can increase your risk for accidents. Medications should be used in combination with good sleep practices.

Here are some medications that can be used to treat insomnia.

  • Antidepressants: Some antidepressant drugs, such as trazodone (Desyrel), are very good at treating sleeplessness and anxiety.
  • Benzodiazepines: These older sleeping pills -- emazepam (Restoril), triazolam (Halcion), and others -- may be useful when you want an insomnia medication that stays in the system longer. For instance, they have been effectively used to treat sleep problems such as sleepwalking and night terrors. These medications have some serious downsides. They can cause addiction and dependence. Dependence means that you have physical withdrawal when you stop them, which you can have in the case of benzos. Also, there is a black box warning against their use with opioids, because both depress respiration and increase your risk of overdose.
  • Doxepine (Silenor): This sleep drug is approved for use in people who have trouble staying asleep. Silenor may help with sleep maintenance by blocking histamine receptors. Do not take this drug unless you are able to get a full 7 or 8 hours of sleep.
  • Eszopiclone (Lunesta): Lunesta also helps you fall asleep quickly, and studies show people sleep an average of 7 to 8 hours. Don't take Lunesta unless you are able to get a full night's sleep as it could cause grogginess. Because of the risk of impairment the next day, the FDA recommends the starting dose of Lunesta be no more than 1 milligram.
  • Lemborexant (Dayvigo): This drug is approved for people who have trouble falling asleep and staying asleep. It works by suppressing the part of the central nervous system that keeps you awake. It may cause you to feel sleepy the next day.
  • Ramelteon (Rozerem): This sleep medication works differently than the others. It works by targeting the sleep-wake cycle, not by depressing the central nervous system. It is prescribed for people who have trouble falling asleep. Rozerem can be prescribed for long-term use, and the drug has shown no evidence of abuse or dependence.
  • Suvorexant (Belsomra): It works by blocking a hormone that promotes wakefulness and causes insomnia. It is approved by the FDA to treat people that have insomnia due to an inability to fall asleep or to stay asleep. The drug may cause you to feel sleepy the following day.
  • Zaleplon (Sonata): Of all the newer sleeping pills, Sonata stays active in the body for the shortest amount of time. That means you can try to fall asleep on your own. Then, if you're still staring at the clock at 2 a. m., you can take it without feeling drowsy in the morning. But if you tend to wake during the night, this might not be the best choice for you.
  • Zolpidem (Ambien, Edluar, Intermezzo): These medicines work well at helping you get to sleep, but some people tend to wake up in the middle of the night. Zolpidem is now available in an extended release version, Ambien CR. This may help you go to sleep and stay asleep longer. The FDA warns that you should not drive or do anything that requires you to be alert the day after taking Ambien CR because it stays in the body a long time. You should not take zolpidem unless you are able to get a full night's sleep -- at least 7 to 8 hours. In rare instances, these medications have been known to cause injuries because of behaviors while asleep or partially asleep such as sleep walking and sleep driving, among others. The FDA has approved a prescription oral spray called Zolpimist, which contains zolpidem, for the short-term treatment of insomnia brought on by trouble falling asleep.
  • Over-the-counter sleep aids: Most of these sleeping pills are antihistamines. There is no proof that they work well for insomnia, and they can cause some drowsiness the next day. They're safe enough to be sold without a prescription. But if you're taking other drugs that also contain antihistamines -- like cold or allergy medications -- you could inadvertently take too much.

If these medications don’t work for you, your doctor may suggest something off-label. These are medications used to treat conditions they weren’t originally made for. Older antidepressants are sometimes prescribed to treat insomnia because they change brain chemicals, which can help regulate sleep. These older medications also tend to have a sedative effect or make you sleepy. They include:

  • Amitriptyline (Elavil)
  • Mirtazapine (Remeron SolTab, Remeron)
  • Nortriptyline (Aventyl, Pamelor)
  • Trazodone

The FDA issued warnings for prescription sleep drugs, alerting patients that they can cause rare allergic reactions and complex sleep-related behaviors, including "sleep driving. " They also warned people that taking sleeping medication at night can impair their ability to drive or be fully alert -- even the next day.

Keep in mind that sleep drugs are not for long-term use. Talk to your doctor if you’re still having trouble sleeping after 2 weeks.

Common and Potentially Harmful Side Effects

Written by Debra Fulghum Bruce, PhD

Between a third and half of Americans have insomnia and complain of poor sleep. Perhaps you're one of them. If so, you may be considering taking a sleeping pill.

A sleeping pill can help your sleep problems for the short term. But it's important to understand everything you need to know about sleeping pills. That includes knowing about sleeping pill side effects. When you do, you can avoid misusing these sedatives.

What Are Sleeping Pills?

Most sleeping pills are classified as "sedative hypnotics." That's a specific class of drugs used to go to sleep or stay asleep. Sedative hypnotics include benzodiazepines, barbiturates, and various hypnotics.

Benzodiazepines such as Ativan, Librium, Valium, and Xanax are anti-anxiety medications. They also increase drowsiness and help people sleep. Halcion is an older benzodiazepine sedative-hypnotic medicine that has largely been replaced by newer medicines. While these drugs may be useful for the short term, all benzodiazepines are potentially addictive and can cause problems with memory and attention. They are usually not recommended for long-term treatment of sleeping problems.

Barbiturates, another group of drugs in this sedative-hypnotic class, depress the central nervous system and can cause sedation. Short- or long-acting barbiturates are prescribed as sedatives or sleeping pills. But more commonly, these hypnotic drugs are limited to use as anesthesia. They can be fatal in overdose.

Newer medications help you fall asleep faster. Some of these sleep-inducing drugs, which bind to the same receptors in the brain as do benzodiazepines, include Ambien, Lunesta, and Sonata. They are somewhat less likely than benzodiazepines to be habit-forming, but over time can still sometimes cause physical dependence. They can work quickly to increase drowsiness and sleep. Another sleep aid, called Rozerem, acts differently from other sleep medicines. It affects a brain hormone called melatonin, and it's not addictive. Belsomra is another unique sleep aid that affects a brain chemical called orexin and is not addictive. Another sleep medicine that is not addictive, Silenor, is a low-dose form of the tricyclic antidepressant doxepin.

What Are the Side Effects of Sleeping Pills?

Like most medications, sleeping pills have side effects. You won't know, though, whether you will have side effects with a particular sleeping pill until you try it.

Your doctor may be able to tell you about some side effects if you have asthma or other health conditions. Sleeping pills can interfere with normal breathing and can be dangerous in people who have certain chronic lung problems such as asthma , emphysema, or forms of chronic obstructive pulmonary disease (COPD).

Common side effects of prescription sleeping pills such as Ambien, Halcion, Lunesta, Rozerem, and Sonata include:

  • Burning or tingling in the hands, arms, feet, or legs
  • Changes in appetite
  • Constipation
  • Diarrhea
  • Balance problems
  • Dizziness
  • Daytime drowsiness
  • Dry mouth or throat
  • Gas
  • Headache
  • Heartburn
  • Impairment the next day
  • Mental slowing or problems with attention or memory
  • Stomach pain or tenderness
  • Uncontrollable shaking of a part of the body
  • Unusual dreams
  • Weakness

It's important to be aware of possible sleeping pill side effects so you can stop the drug and call your doctor immediately to avoid a more serious health problem.

Sleeping Pills and Older Adults

If you’re 65 or older, experts suggest that you avoid all sleep aids. This includes over-the-counter drugs and the newer “Z” drugs like eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien).

Compared to younger people, older adults have a greater chance of health problems on sleep meds. When you’re older, sleeping pills tend to stay in your system longer. Drowsiness can last into the day after you’ve taken them. Confusion and memory problems are also a known side effect. For older adults, this could result in falls, broken hips, and car accidents.

Other symptoms of some over-the-counter sleep medications can be especially hard for older adults to handle. Your mouth may be dry. You may also be constipated and find it hard to pee.

Before you decide to take sleeping pills, talk to your doctor. They may recommend a medical exam to help you figure out the cause of your sleep problems, like depression, anxiety, or a sleep disorder.  Your doctor will also suggest ways to treat sleeplessness without drugs.

Are There More Complex Sleeping Pill Side Effects?

Some sleeping pills have potentially harmful side effects, including parasomnias. Parasomnias are movements, behaviors, and actions over which you have no control, like sleepwalking. During a parasomnia, you are asleep and unaware of what is happening.

Parasomnias with sleeping pills are complex sleep behaviors and may include sleep eating, making phone calls, or having sex while in a sleep state. Sleep driving, which is driving while not fully awake, is another serious sleeping pill side effect. Though rare, parasomnias are difficult to detect once the medication takes effect.

Product labels for sedative-hypnotic medicines include language about the potential risks of taking a sleeping pill. Because complex sleep behaviors are more likely to occur if you increase the dosage of a sleeping pill, take only what your doctor prescribes -- no more.

Can I Be Allergic to Sleeping Pills?

Yes. People can have an allergic reaction to any medicine, which could be related to either the active ingredient of the medicine itself or to any of its inactive ingredients (such as dyes, binders or coatings). People who have an allergic reaction to a specific sleeping pill should avoid it. It's important to talk to your doctor at the first sign of these serious side effects, including:

  • Blurred vision or any other problems with your sight
  • Chest pain
  • Difficulty breathing or swallowing
  • Feeling that the throat is closing
  • Hives
  • Hoarseness
  • Itching
  • Nausea
  • Pounding heartbeat
  • Rash
  • Shortness of breath
  • Swelling of the eyes, face, lips, tongue, or throat
  • Vomiting

In addition, a serious -- even deadly -- side effect of any medicine someone is allergic to is anaphylaxis. Anaphylaxis is an acute allergic reaction. Another possible effect is angioedema, which is severe facial swelling. Again, discuss these possibilities with your doctor if you are at risk of allergic reactions.

When Do I Take a Sleeping Pill?

It's usually recommended that you take the sleeping pill right before your desired bedtime. Read your doctor's instructions on the sleeping pill prescription label. The instructions have specific information regarding your medication. In addition, always allow ample time to sleep before you take a sleeping pill.

Is It Dangerous to Combine Sleeping Pills and Alcohol?

Yes. Mixing alcohol and sleeping pills can have additive sedating effects from both drugs, and the combination can cause someone to stop breathing, which could cause death. Sleeping pill labels warn against using alcohol while taking the drug.

Also, you should not eat grapefruit or drink grapefruit juice while taking some sleeping pills. Grapefruit increases the amount of the drug absorbed into your bloodstream and how long it stays in the body. That can cause over-sedation.

Can I Become Dependent on Sleeping Pills?

For short-term insomnia, your doctor may prescribe sleeping pills for several weeks. Yet after regular use for a longer period, some sleeping pills such as benzodiazepines or benzodiazepine agonists such as zolpidem or eszopiclone may stop working as you build a tolerance to the medication. (However, tolerance has not been shown with non-habit-forming sleeping pills like Belsomra, Rozerem, or Silenor.) You may also become psychologically dependent on the medicine. Then the idea of going to sleep without it will make you anxious.

Without the sleeping pill, you might find it difficult to sleep. If that happens, it could be a sign of a physical or emotional dependence or both. Some studies show that long-term use of sleeping pills actually interferes with sleep. The best way to avoid developing a physical or emotional dependence on sleeping pills is to follow your doctor's instructions and stop taking the drug when recommended.

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How sleeping pills work and what insomnia is

Science has 82 types of sleep disorders, including such exotic things as stopping breathing during sleep - “apnea”. The study of such disorders is carried out by a special science of sleep - somnology. After examining and taking anamnesis, somnologists can prescribe special sleeping pills, the principle of which we will tell you about.

Perhaps everyone in this life has suffered from insomnia. On the eve of a holiday, before a difficult exam or interview, and sometimes just "because of the full moon." Everyone struggles with the inability to fall asleep in different ways - someone drinks sleeping pills, someone drinks a glass of cognac at night, someone herbal tea, and some try to ensure a calm and quick falling asleep by following simple rules - ventilate the room before going to bed and drink a glass warm milk. All this is effective in its own way, but it does not help everyone. And although knowledge of the mechanisms of sleep in itself does not save from insomnia, nevertheless, this topic is close to everyone.

Do not self-medicate! In our articles, we collect the latest scientific data and the opinions of authoritative health experts. But remember: only a doctor can diagnose and prescribe treatment.

What is sleep

Sleep is a specific state of the nervous system, which manifests itself in the interruption of human ties with the outside world. As Leonardo da Vinci said about sleep, “sleep is a desired state that, once achieved, disappears for consciousness.” Little is known about sleep. The mechanisms of the brain that cause or regulate sleep and awakening are relatively well studied, but, for example, to the question “why sleep at all?” There is no definite answer yet, although there are many hypotheses. For example, some believe that unnecessary neural connections are destroyed during sleep, saving the brain from storing meaningless information. But so far it is only obvious that sleep is a biological human need: everyone has heard about the terrible torture of insomnia, and there is no doubt that sleep is necessary.

Falling asleep

In the nervous system, activity is regulated by two types of neurons - excitatory and inhibitory. They, respectively, release either excitatory or inhibitory neurotransmitters. The former excite the activity of the postsynaptic neuron, the latter suppress it. Sleep pills have their hypnotic effect on the body due to the influence of inhibitory mediators on the brain structure, which is responsible for "tuning" the nervous system to active work (it is called the reticular activating system).

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The main mediator that induces sleep is serotonin. Under its influence, neurons of a certain part of the brain are excited, which in turn activate neurons that release inhibitory neurotransmitters. Norepinephrine, on the contrary, is responsible for awakening. The subtleties of the interaction of brain structures with serotonin and norepinephrine have not been studied, but the fact that they take some part in the regulation of sleep and wakefulness is known for sure. Further, it is obvious that if inhibitory mediators are not enough to extinguish the activity of the desired part of the brain, falling asleep does not occur . As an illustration, everyone can remember that we usually cannot fall asleep when our nervous system is in an excited state - this is manifested in the fact that we cannot get rid of obsessive thoughts, constantly tossing and turning - we are either hot, or cold, or uncomfortable, we are annoyed by any rustle, etc.

Insomnia

According to various sources, from 25 to 50 percent of the world's population suffers from insomnia, and 95 percent have experienced it at least once in their lives. Interestingly, insomnia indirectly affects even mortality - people with sleep disorders are 2.5 times more likely to get into car accidents. Insomnia is defined as a decrease in the amount and quality of sleep (and sometimes a change in the timing of sleep).

Everything is clear with quantity, but about quality (this is when you slept for twelve hours, but still “did not get enough sleep”) must be said separately. Research shows that normal sleep always has several phases - namely five. During each phase, the nature and amplitude of the waves of electrical activity of the brain on the encephalogram changes - according to these signs they are divided. In fact, the phase of sleep determines its depth: the first phase is the most superficial sleep, the fifth is the deepest. The fifth phase is also called REM sleep, or REM sleep, and the first four phases are therefore called non-REM sleep. To avoid confusion, I would like to emphasize that it is REM sleep that is the deepest and, although breathing and heartbeat are speeded up, the skeletal muscles of the sleeper are completely relaxed. Almost all people awakened during this phase say that they had dreams. So: it is known that the amount of REM and non-REM sleep must be balanced in a certain way. If any phases in a dream are missing, or they are very short, a person does not receive the necessary rest in a dream. For example, in one experiment, rats that were woken up whenever they entered REM sleep very soon went into nervous exhaustion and then death.

Although everyone's need for sleep is different, everyone feels the amount and quality of sleep subjectively, assessing whether he "gets enough sleep" or not. Some (Napoleon Bonaparte is said to be one of these) feel cheerful after four hours of sleep, and some (including the author) even after eight hours with difficulty force themselves to wake up. And, of course, there are "owls" and "larks".

"For ease of reference" insomnia is classified according to the period in which difficulties with sleep appear - that is, they distinguish presomnic disorders (problems with falling asleep), intrasomnic (frequent awakenings) and postsomnic (early waking up, daytime sleepiness, decreased performance in the morning).

Sleeping pills

The mechanism of action of sleeping pills is very complex and, like sleep itself, has not been studied enough, but what is known is quite enough for a general acquaintance with their action. Today, a well-known inhibitory neurotransmitter is gamma-aminobutyric acid (GABA). For the first time, gamma-aminobutyric acid was discovered in the brain by E. Roberts and S. Frenkel in 1950. But its main property - the ability to reduce the activity of the nervous system - was discovered in 1963 by the English scientist K. Krnevich. Thus, to create a sleeping pill means either to increase the effect of GABA on neurons, or to increase its amount in the nervous system.

Barbiturates

The very first sleeping pills were discovered experimentally long before the existence of GABA was known. These were barbiturates (for example, veronal).

The mechanism of their action of these hypnotic drugs was already clarified during studies of the mechanisms of inhibition in the nervous system - it was found that the postsynaptic receptors of neurons responsible for inhibition are sensitive not only to GABA, but to varying degrees and to some other substances - in particular, to derivatives of barbiturates. Barbiturates, when attached to such receptors, lengthen the time of GABA exposure and also enhance this effect. However, due to the fact that receptors sensitive to barbiturates are responsible not only for sleeping pills, but also for anticonvulsant and relaxing effects, these sleeping pills there is a very pronounced side effect on the body (some drugs are even used in the treatment of epilepsy). In addition, with prolonged use of them as sleeping pills, the most important phase of REM sleep is shortened, that is, sleep is different from normal (in fact, sleep after such sleeping pills is only a physical state similar to sleep). Another trouble is the development of drug dependence with constant use for 1-3 months (and addiction develops in general in two weeks). Today, barbiturates are practically not used as sleeping pills.

GABA

After the discovery of GABA, an attempt was made to use the acid itself in its pure form as a sleeping pill (gamma-aminobutyric acid is a white powder soluble in water). However, it turned out that GABA practically does not get from the blood to the brain and, accordingly, the drug is ineffective, and has no effect on the human body.

Benzodiazepines

In further studies, it was found that some postsynaptic disorders are sensitive to benzodiazepine derivatives, and in the 60s of the XX century, the second generation of sleeping pills appeared. Benzodiazepines also indirectly (by attaching to "their" receptors) enhance the action of GABA. Since the receptors sensitive to these drugs are mainly responsible for the hypnotic effect, they have less side effects on the body than barbiturates. But some of the problems still remained: addiction, withdrawal syndrome, the need to constantly increase the dosage. In addition, although the REM phase is not shortened, the phase ratio does not correspond to physiological sleep, and heavy waking and daytime sleepiness limit the use of these hypnotics (in particular, you should not drive a car during the treatment period).

Latest generation

Further progress in the treatment of insomnia was marked by the discovery of several different types of receptors. It turned out that by selectively influencing some of them, it is possible to very accurately influence the braking mechanisms. This is how selective drugs appeared - the latest generation of sleeping pills. These are derivatives of imidazoperidine (ivadal) and cyclopyrrolone (imovan). The number of side effects they have is minimal, and the distribution of sleep phases is natural. True, the ideal has not yet been achieved - with prolonged use, there is still a danger of developing addiction. It is important to know that the effect of all sleeping pills is enhanced by alcohol (and vice versa, the effect of alcohol is potentiated by sleeping pills).

Histamine

Histamine is one of the most important mediators of wakefulness, so blocking histamine receptors (that is, receptors for neurons that are excited by histamine) also produces a hypnotic effect.

Drugs that block histamine receptors are called antihistamines. Their main task is to treat allergies, however, some pills can act as sleeping pills - this is considered a harmful additional property. Nevertheless, for some of these drugs (for example, diphenhydramine, pipolfen, donormil) it is so strong that they are considered full-fledged hypnotics. Fortunately, modern antihistamines are almost completely devoid of hypnotic action, since they do not pass through the blood-brain barrier brain) and do not affect the nervous system. Therefore, they can be taken constantly, without fear that during the flowering period of some next plant to which your body is hypersensitive, you will have to choose between sneezing and sleeping at work.

Melatonin

Melatonin is a neurohormone that is synthesized in our body from serotonin in the epiphysis, retina and intestines. The enzymes responsible for converting serotonin to melatonin are inhibited by light, so melatonin production is light dependent.

In humans, about 70% of the daily melatonin production occurs at night. Melatonin is somehow involved in the regulation of human circadian (daily) rhythms, that is, the rhythms of sleep and wakefulness. In particular, under the influence of melatonin, the amount of GABA in the nervous system increases.

Melatonin is considered a mild sedative and is recommended for minor sleep disturbances, including for faster adaptation when flying to other time zones. It also accelerates the adaptation of the body in a stressful situation and exhibits immunostimulating and antioxidant properties.

The ideal sleeping pill

In the light of the above, it becomes clear that very often the problem with insomnia is the usual overexcitation, so the recommendations “read at night” and “drink valerian” (which, by the way, also acts as a sleeping pill) can be effective . However, the scale of the production of sleeping pills indicates that it still has little effect on anyone.

The goal of any pharmacological research into sleeping pills is, of course, to find the perfect sleeping pill. In dreams, it is seen as follows: it acts quickly, does not lose effectiveness with prolonged use, is safe in case of overdose, does not have any effects other than sleeping pills, and also does not affect awakening, does not disturb sleep phases and does not change their normal ratio, does not cause disorders of the nervous system. system and problems upon termination of use.

So far, such a medicine has not yet been created, and it is unlikely that it will appear in the near future, although even now the first sleeping pills seem to be downright poison compared to modern ones.

Sleeping pill poisoning

Sleeping pills are sold by prescription in our pharmacies. The reason is known - in large doses, barbiturates and benzodiazepines are life-threatening.

Learn more